The dreaded disease, Chronic Kidney Disease (CKD) is defined as a progressive loss in kidney function over a period of months or years. Each kidney has about a million tiny filters, called nephrons and if they are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But, if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.

When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body, and can make you feel very ill. Untreated kidney failure can be life-threatening.

The causes for CKD include high blood pressure (hypertension) and diabetes. The high blood pressure causes just over a quarter of all cases of kidney failure. Diabetes has been established as the cause of around one-third of all cases and is the commonest cause of ESRD in most developed countries.

However, what is faced by Sri Lanka is a disease for which the causes are not very clear. Hence, it is described as Chronic Kidney Disease of Unknown Aetiology (CKDu). It is a Chronic Kidney Disease of unidentifiable origin. It has become a major health issue over the past two decades. This is a different form of kidney disease, which is not associated with conventional risk factors such as, diabetes and hypertension.

It was first detected in the dry zone of Rajarata, comprising the Polonnaruwa and Anuradhapura districts. But, in recent years it has been spreading in various parts of Sri Lanka, at an unprecedented level. The latest medical surveys say, CKDu patients have been detected in 11 districts in the country. This is a relatively new phenomenon that Sri Lankans and the Sri Lankan Government is faced with.

Farming community

One conclusion of the experts who studied the causes of CKDu is that the persons afflicted are mostly from the poorer sections of the community. All the provinces affected have large underdeveloped areas and of the afflicted, about 67% belong to the low income farming community and another 30% from the poorest segment of the unemployed.

The CKDu is not present in relatively developed provinces such as Western, Wayamba, Sabaragamuwa and Central. In the South, only the least developed, Hambantota is affected. However, another alarming development is that a few patients were detected in Ratnapura recently, although Sabaragamuwa is considered to be one of the safe provinces.

In the last decade, it was found that almost 5,000 additional cases of CKDu were detected annually. By the end of 2016, the total CKDu affected persons was over 60,000 according to official estimates. However, if an island wide campaign is conducted, the number could even double as there are many undetected patients.

The Health Ministry stated that the less common conditions of CKD include inflammation (glomerulonephritis) or infections (pyelonephritis). Sometimes, CKD is inherited and it could also be due to longstanding blockage to the urinary system. Furthermore, it could be related to medicinal drugs, especially, some pain-killing drugs if taken over a long time. Often, doctors cannot determine what caused the problem.

CKDu is strongly suspected to be due to insecticides, chemical fertilizer and contaminated water. In response to the scope and severity of the emerging CKDu health crisis, the then Minister of Health, Maithripala Sirisena sought assistance from the World Health Organization to initiate a collaborative research project from 2009 through 2012 to investigate CKDu prevalence and aetiology.

Recently, President Sirisena called on friendly countries and the local private sector to get involved in the CKDu eradication campaign and several philanthropists came forward to assist. China, immediately offered to set up a hospital for CKDu patients in Polonnaruwa at a cost of 600 million Yuan. When President Sirisena met with Chinese President Xi Jinping in Beijing the latter made this announcement. The project is scheduled to take off this year.

Water purification

The association of the Chairman of the Galle Face Hotel Group, Sanjeev Gardiner set up a group for the prevention of Chronic Kidney disease in Sri Lanka, which was established in line with a sustainable program to control CKD according to the concept of the President. The activities of this group include water purification plan in CKD affected areas in the North Central Province.

The President has initiated a ten-year National Health Policy and CKDu prevention is part of the plan. Its first draft was presented at a meeting chaired by President Sirisena. The meeting revealed that the main reason for most of the prevailing diseases are the use of chemical for agricultural purpose and attention was drawn to steps that could be taken to minimize this situation.

The Presidential Task Force organized a three-day international expert consultation to guide on future direction for addressing CKDu and its recommendations were presented to President Sirisena by the WHO Representative to Sri Lanka, Dr Jacob Kumaresan.

The objective of the consultation was to review the knowledge on CKDu globally and in Sri Lanka, identify gaps, prioritize an interdisciplinary collaborative research agenda and recommend interventions based on the available evidence.

The consultation also aimed at developing consensus on the monitoring and accountability framework for the implementation of the recommendations. There were participants from 54 countries at the Consultation Workshop. The experts studied the current state of the problem of CKDu and the gaps that needed to be filled.

They came up with recommendations to: develop a robust surveillance system; establish a consortium of national/international researchers; strengthen the implementation of available interventions; provide social support at three levels; strengthen / expand human resources at various levels and develop a framework for monitoring and accountability.

Double blow

The CKDu is a double blow to the economy of Sri Lanka as it affects the farmer community and, in turn, the food production in the country. In addition to revenue losses to the nation, it adds up expenditure for health service, which is totally free in Sri Lanka.

As Dr Asoka Bandarage stated in a recent study, even when Sri Lankan farmers are aware of the extreme dangers of some of the agrochemicals, they lack proper equipment and protective gear for safe use or facilities for safe storage. As a result, occupational and accidental pesticide poisoning is rampant. In the late 1970s, Sri Lanka had the highest rate of pesticide poisoning in the world.

The Food and Agriculture Organization also stated that Sri Lanka still rank very high in the Asia Pacific Region with regard to pesticide related health hazards, with an annual total number of pesticide accidents around 20,000.

Realizing the danger posed by the rapidly spreading CKDu, several ministries have launched special campaigns to contain this disease, treat the patients and look after the affected families.

While the Ministry of Health is handling the treatment of patients, Ministry of Water Supply has been entrusted with the task of supplying drinking water to areas where water is contaminated.

The Ministry of Social Services is taking care of the welfare of the families that are economically hit when the breadwinner is down with CKDu. The Ministry of Agriculture has launched a campaign to reduce the use of chemical fertilizer and promote organic fertilizer. All these activities of the different Ministries are coordinated by the central body, the Presidential Task Force.